- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (St. Paul, MN)
- …Work hours will be an 8.5-hour shift between 7:00am - 5:00pm CST. The Utilization Management Nurse 2 uses knowledge, communication, and independent critical ... Qualifications** + Associate's Degree or higher + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary...a team **Preferred Qualifications** + BSN + Knowledge of Utilization Management + Previous Medicare and Medicaid… more
- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CenterWell (St. Paul, MN)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Cognizant (St. Paul, MN)
- …background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CenterWell (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...volume and fast paced environment + Previous experience in utilization management + Education: BSN or bachelor's… more
- Humana (St. Paul, MN)
- **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... and communication of behavioral health services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse 2 work… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Staff Nurse *to join our Utilization Management department for the/Emergency Department / This position is a*0.8 FTE ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...to 5) years of professional leadership experience (ie, charge nurse , team leader, preceptor, committee chair, etc.) * Five… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Case Management Assistant* to join our Utilization Management team. This position works on campus, part-time, .6 (48 ... IMM is in the medical record * Assist UR nurse with clerical support (faxing, follow-up calls) for payor...and regulations * Epic * MS Office **Title:** *Case Management Assistant- Utilization Management * **Location:**… more
- Sharecare (St. Paul, MN)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Fairview Health Services (Edina, MN)
- …not limited to: assessment, care planning, service coordination and referral, transition management , utilization management and quality assurance. The care ... Medicaid benefits and senior care industry + Public Health Nurse + Certification in case management +...Public Health Nurse + Certification in case management + gerontological nursing **Benefit Overview** Fairview offers a… more
- Fairview Health Services (Maplewood, MN)
- …for services provided + Completes the requirements of various payers and utilization management reviewers to obtain authorization for treatment. Demonstrates the ... as an interdisciplinary team member. Responsible, as assigned, for the management of caseload. **Job Expectations:** Works collaboratively with the physician and… more
- Highmark Health (St. Paul, MN)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Fresenius Medical Center (Shakopee, MN)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... and member satisfaction. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie LICSW, LPCC,...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a*Teen and Family Case Management Assistant*to join our Aqui Para Ti team. This part-time role will work 40 hours within a two ... delivery of cost-effective health care and identify the appropriate utilization of resources. Coaches patients and parents/caregivers in developmentally appropriate… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …bilingual Spanish speaker * 1+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience. * ... across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more
- Datavant (St. Paul, MN)
- …function as delegated by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal ... of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for...expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … experience. * 1+ years of managed care experience, eg case management /health coach, utilization management and/or auditing experience. Compensation ... US Minimum Experience Required 1+ years of managed care experience, eg case management /health coach, utilization management and/or auditing experience. Shift… more